Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
ISSN
1437-4331
See all formats and pricing
More options …
Volume 57, Issue 9

Issues

Narrowed reference intervals for complete blood count in a multiethnic population

Seungok Lee
  • Department of Laboratory Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
  • Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Chui Mei Ong / Yu Zhang / Alan H.B. Wu
  • Corresponding author
  • Department of Laboratory Medicine, University of California, San Francisco, CA 94110, USA
  • Clinical Laboratories, Room 2M27, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 94110, USA, Phone: +1-415-206-3540, Fax: +1-415-206-3045
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-02-12 | DOI: https://doi.org/10.1515/cclm-2018-1263

Abstract

Background

Biological variation studies have shown that the complete blood count (CBC) has narrow within-individual variation and wide group variation, indicating that the use of reference intervals (RIs) is challenging. The aim of this study was to examine differences in CBC RIs according to race/ethnicity in a multiethnic population at a hospital in San Francisco in hopes of improving the medical utility of CBC testing.

Methods

Subject data were obtained by screening CBC results from the medical records of outpatients meeting certain criteria who visited Zuckerberg San Francisco General Hospital from April 2017 to January 2018. From these records, sex- and race/ethnicity-specific CBC RIs were calculated as the 2.5th to 97.5th percentiles.

Results

From a total of 552 subjects, 47.9% were male (65 White, 50 Black, 71 Hispanic and 54 Asian) and 52.1% were female (51 White, 39 Black, 122 Hispanic and 72 Asian). The RIs of neutrophil, lymphocyte and eosinophil counts; and hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) showed significant differences (p<0.05) among the four racial/ethnic groups: neutrophil, lymphocyte and eosinophil counts; and MCHC in males, and hemoglobin, MCV, MCH and MCHC in females.

Conclusions

Race/ethnicity-specific CBC RIs should be taken into consideration in a multiethnic population to better interpret patient status and make progress toward precision medicine.

Keywords: complete blood count; multiethnic population; race/ethnicity; reference interval

References

  • 1.

    Fraser CG. The utility of population-based reference values. In: Fraser CG, editor. Biological variation: from principles to practice. Washington, DC: AACCPress, 2013:91–115.Google Scholar

  • 2.

    Westgard QC. Available at: https://www.westgard.com/biodatabase1.htm. Accessed on 10 May, 2018.

  • 3.

    Shaper AG, Lewis P. Genetic neutropenia in people of African origin. Lancet 1971;2:1021–3.PubMedGoogle Scholar

  • 4.

    Ezeilo GC. Non-genetic neutropenia in Africans. Lancet 1972;300:1003–4.CrossrefGoogle Scholar

  • 5.

    Bain BJ, England JM. Normal haematological values: sex difference in neutrophil count. Br Med J 1975;1:306–9.PubMedCrossrefGoogle Scholar

  • 6.

    Rougemont A, Boisson ME. Letter: racial differences in leucoyte count. Br Med J 1975;2:684–5.PubMedCrossrefGoogle Scholar

  • 7.

    Bain BJ. Ethnic and sex differences in the total and differential white cell count and platelet count. J Clin Pathol 1996;49:664–6.PubMedCrossrefGoogle Scholar

  • 8.

    Lim EM, Cembrowski G, Cembrowski M, Clarke G. Race-specific WBC and neutrophil count reference intervals. Int J Lab Hematol 2010;32:590–7.CrossrefPubMedWeb of ScienceGoogle Scholar

  • 9.

    Segal JB, Moliterno AR. Platelet counts differ by sex, ethnicity, and age in the United States. Ann Epidemiol 2006;16:123–30.PubMedCrossrefGoogle Scholar

  • 10.

    Horn PS, Pesce AJ. Effect of ethnicity on reference intervals. Clin Chem 2002;48:1802–4.PubMedGoogle Scholar

  • 11.

    Lim E, Miyamura J, Chen JJ. Racial/ethnic-specific reference intervals for common laboratory tests: a comparison among Asians, Blacks, Hispanics, and White. Hawaii J Med Public Health 2015;74:302–10.PubMedGoogle Scholar

  • 12.

    Clinical and Laboratory Standard Institute. Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline, 3rd ed., CLSI document EP28-A3c. Wayne, PA: Clinical and Laboratory Standard Institute, 2010.Google Scholar

  • 13.

    Lippi G, Giavarina D, Gelati M, Salvagno GL. Reference range of hemolysis index in serum and lithium-heparin plasma measured with two analytical platforms in a population of unselected outpatients. Clin Chim Acta 2014;429:143–6.Web of ScienceCrossrefGoogle Scholar

  • 14.

    Ehrenkranz J, Bach PR, Snow GL, Schneider A, Lee JL, Ilstrup S, et al. Circadian and circannual rhythms in thyroid hormones: determining the TSH and free T4 reference intervals based upon time of day, age, and sex. Thyroid 2015;25:954–61.Web of SciencePubMedCrossrefGoogle Scholar

  • 15.

    Milinković N, Ignjatović S, Žarković M, Jovičić S, Radosavljević B, Singh S, et al. Indirect estimation of age-related reference limits of thyroid parameters: a cross-sectional study of outpatients’ results. Scand J Clin Lab Invest 2014;74:378–84.Web of SciencePubMedCrossrefGoogle Scholar

  • 16.

    Roehrl MH, Lantz D, Sylvester C, Wang JY. Age-dependent reference ranges for automated assessment of immature granulocytes and clinical significance in an outpatient setting. Arch Pathol Lab Med 2011;135:471–7.Google Scholar

  • 17.

    Qiao R, Yang S, Yao B, Wang H, Zhang J, Shang H. Complete blood count reference intervals and age- and sex-related trends of North China Han population. Clin Chem Lab Med 2014;52:1025–32.PubMedWeb of ScienceGoogle Scholar

  • 18.

    Ambayya A, Su AT, Osman NH, Nik-Samsudin NR, Khalid K, Chang KM, et al. Haematological reference intervals in a multiethnic population. PLoS One 2014;9:e91968.CrossrefWeb of ScienceGoogle Scholar

  • 19.

    Fraser CG. The nature of biological variation. In: Fraser CG, editor. Biological variation: from principles to practice. Washington, DC: AACC Press, 2013:1–27.Google Scholar

About the article

Received: 2018-11-26

Accepted: 2019-01-15

Published Online: 2019-02-12

Published in Print: 2019-08-27


Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 57, Issue 9, Pages 1382–1387, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2018-1263.

Export Citation

©2019 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Comments (0)

Please log in or register to comment.
Log in